Balance of neutralizing Antibodies and Antibody Dependent Enhancement (ADE) In Dengue Virus (DENV) infection: a literature review

Dengue fever is a major public health concern worldwide, especially in regions with warm temperatures. Dengue Virus (DENV) from Flaviviridae, which has 4 serotypes DENV-1, DENV-2, DENV-3, and DENV-4) caused Dengue. DENV can cause three different types of dengue fever: Classical DF, DHF, and DSS. To fight off DENV infection, the body will produce an immunological response. Neutralizing antibodies are one of the immune responses that play a role in preventing viral infections. However, antibodies can also contribute to DENV infection severity through a process called Antibody Dependent Enhancement (ADE). The amount of antibodies bound to virus particles is related to viral neutralization and ADE. Neutralization occurs when antibody concentrations exceed the stoichiometric threshold and when antibody concentrations are higher than the minimal amount that is required for stable attachment of virions to cells. ADE occurs in the presence of antibodies below the stoichiometric threshold for neutralization and less than the minimal amount required for stable attachment of viral particles to cells. Antibody binding stoichiometry is determined by the affinity of the antibody and the number of epitopes that can bind to the virion. According to scholarly discourse, it is commonly held that the balance between neutralizing antibodies and ADE can be influenced by two contexts, namely the affinity and amount of antibodies.